Provider Demographics
NPI:1376652073
Name:MATTERN, RICHARD F (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
Last Name:MATTERN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4 BRIGHTON ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012
Mailing Address - Country:US
Mailing Address - Phone:973-284-0020
Mailing Address - Fax:973-284-6310
Practice Address - Street 1:20 HIGH ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1132
Practice Address - Country:US
Practice Address - Phone:973-284-0020
Practice Address - Fax:973-284-6310
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA037536002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1820800Medicaid
NJ403024Medicare PIN
C58271Medicare UPIN